Cryoablation Procedures Comparable

Laparoscopic and percutaneous approaches have similar short-term efficacy in treating renal tumors.

Laparoscopic (LAP) and CT-guided percutaneous (PERC) cryoablation for renal tumors result in similar short-term outcomes, but the PERC approach may offer advantages with respect to hospital stay, need for narcotics, and development of atelectasis, researchers reported.

Ithaar H. Derweesh, MD, of the University of Tennessee Health Science Center in Memphis, and his colleagues compared the two procedures in 60 patients. Of these, 34 patients (mean age 67 years) underwent a LAP and 26 (mean age 69.7 years) underwent a PERC procedure. LAP cryoablation was performed transperitoneally with ultrasonographic monitoring.

On the average, LAP patients had a BMI of 29.8 kg/m2 and tumor size of 2.9 cm; PERC patients had a BMI of 28.7 and a tumor size of 3.1 cm.] In patients undergoing LAP procedures, the tumors were anterior, posterior, and central in 61.8%, 32.4%, and 5.8% of patients, respectively; in patients undergoing PERC procedures, tumors were anterior, posterior, and central in 15.4%, 65.4%, and 19.2% of patients. Mean follow-up was 25 months.

The LAP procedure took significantly longer than the PERC procedure (mean 165.7 vs. 106.6 minutes) and was associated with a significantly longer hospital stay (2.6 vs. 1.8 days), according to a report in the Journal of Endourology (2008; published online ahead of print). More patients who underwent the LAP procedure, however, required postoperative narcotics (82.4% vs. 19.2%). Atelectasis developed in 70.6% of LAP patients compared with 34.6% of PERC patients.

Complications developed in 14.7% of LAP patients and 26.9% of PERC patients, but the difference was not statistically significant. Persistent residual enhancement at six months was observed in four patients: three in the PERC group (11.5%) and one in the LAP group (2.9%). Three of the four patients had a tumor size greater than 4 cm. The three-year disease-specific survival rate for the two groups was 100%.

“The effectiveness of PERC cryoablation appears to remain comparable to LAP cryoablation while recovery is expedited and postoperative pain is reduced,” the authors concluded.

The investigators noted that their study is limited by its retrospective design, the relatively small patient numbers and short follow-up period, and the fact that they treated patients regardless of biopsy. “We did not use biopsy results to guide our treatment plan because of our desire not to overlook pathologically undetected malignancy,” they noted.